Emily L Mueller1, Amber Sabbatini, Achamyeleh Gebremariam, Rajen Mody, Lillian Sung, Michelle L Macy. 1. Department of Pediatrics and Communicable Diseases, Division of Pediatric Hematology Oncology, University of Michigan, Ann Arbor, Michigan; Department of Pediatrics and Communicable Diseases, Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan.
Abstract
BACKGROUND: Little is known about emergency department (ED) use among pediatric patients with cancer. We explored reasons prompting ED visits and factors associated with hospital admission. PROCEDURE: A retrospective cohort analysis of pediatric ED visits from 2006 to 2010 using the Nationwide Emergency Department Sample, the largest all-payer database of United States ED visits. Pediatric patients with cancer (ages ≤19 years) were identified using Clinical Classification Software. Proportion of visits and disposition for the top ten-ranking non-cancer diagnoses were determined. Weighted multivariate logistic regression was performed to analyze factors associated with admission versus discharge. RESULTS: There were 294,289 ED visits by pediatric patients with cancer in the U.S. over the study period. Fever and fever with neutropenia (FN) were the two most common diagnoses, accounting for almost 20% of visits. Forty-four percent of pediatric patients with cancer were admitted to the same hospital, with admission rates up to 82% for FN. Risk factors for admission were: FN (odds ratio (OR) 8.58; 95% confidence interval (CI) 5.97-12.34); neutropenia alone (OR 7.28; 95% CI 5.08-10.43), ages 0-4 years compared with 15-19 years (OR 1.19; 95% CI 1.08-1.31) and highest median household income ZIP code (OR 1.27; 95% CI 1.08-1.49) compared with lowest. "Self-pay" visits had lower odds of admission (OR 0.42; 95% CI 0.35-0.51) compared with public payer. CONCLUSION: FN was the most common reason for ED visits among pediatric patients with cancer and is the condition most strongly associated with admission. Socioeconomic factors appear to influence ED disposition for this population.
BACKGROUND: Little is known about emergency department (ED) use among pediatric patients with cancer. We explored reasons prompting ED visits and factors associated with hospital admission. PROCEDURE: A retrospective cohort analysis of pediatric ED visits from 2006 to 2010 using the Nationwide Emergency Department Sample, the largest all-payer database of United States ED visits. Pediatric patients with cancer (ages ≤19 years) were identified using Clinical Classification Software. Proportion of visits and disposition for the top ten-ranking non-cancer diagnoses were determined. Weighted multivariate logistic regression was performed to analyze factors associated with admission versus discharge. RESULTS: There were 294,289 ED visits by pediatric patients with cancer in the U.S. over the study period. Fever and fever with neutropenia (FN) were the two most common diagnoses, accounting for almost 20% of visits. Forty-four percent of pediatric patients with cancer were admitted to the same hospital, with admission rates up to 82% for FN. Risk factors for admission were: FN (odds ratio (OR) 8.58; 95% confidence interval (CI) 5.97-12.34); neutropenia alone (OR 7.28; 95% CI 5.08-10.43), ages 0-4 years compared with 15-19 years (OR 1.19; 95% CI 1.08-1.31) and highest median household income ZIP code (OR 1.27; 95% CI 1.08-1.49) compared with lowest. "Self-pay" visits had lower odds of admission (OR 0.42; 95% CI 0.35-0.51) compared with public payer. CONCLUSION: FN was the most common reason for ED visits among pediatric patients with cancer and is the condition most strongly associated with admission. Socioeconomic factors appear to influence ED disposition for this population.
Authors: Monica E Kleinman; Leon Chameides; Stephen M Schexnayder; Ricardo A Samson; Mary Fran Hazinski; Dianne L Atkins; Marc D Berg; Allan R de Caen; Ericka L Fink; Eugene B Freid; Robert W Hickey; Bradley S Marino; Vinay M Nadkarni; Lester T Proctor; Faiqa A Qureshi; Kennith Sartorelli; Alexis Topjian; Elise W van der Jagt; Arno L Zaritsky Journal: Circulation Date: 2010-11-02 Impact factor: 29.690
Authors: Swati K Basu; Isabel D Fernandez; Susan G Fisher; Barbara L Asselin; Gary H Lyman Journal: J Clin Oncol Date: 2005-11-01 Impact factor: 44.544
Authors: Joe Xiang; Junxin Shi; Krista Kurz Wheeler; Keith Owen Yeates; H Gerry Taylor; Gary A Smith Journal: Brain Inj Date: 2013-10-08 Impact factor: 2.311
Authors: Thomas Lehrnbecher; Robert Phillips; Sarah Alexander; Frank Alvaro; Fabianne Carlesse; Brian Fisher; Hana Hakim; Maria Santolaya; Elio Castagnola; Bonnie L Davis; L Lee Dupuis; Faith Gibson; Andreas H Groll; Aditya Gaur; Ajay Gupta; Rejin Kebudi; Sérgio Petrilli; William J Steinbach; Milena Villarroel; Theoklis Zaoutis; Lillian Sung Journal: J Clin Oncol Date: 2012-09-17 Impact factor: 44.544
Authors: Sapna Kaul; Heidi Russell; John A Livingston; Anne C Kirchhoff; Daniel Jupiter Journal: J Adolesc Young Adult Oncol Date: 2018-06-20 Impact factor: 2.223
Authors: Henry E Rice; Brian R Englum; Brian C Gulack; Obinna O Adibe; Elizabeth T Tracy; Susan G Kreissman; Jonathan C Routh Journal: Pediatr Blood Cancer Date: 2015-03-21 Impact factor: 3.167
Authors: M Katherine Henry; Joanne N Wood; Kristina B Metzger; Konny H Kim; Chris Feudtner; Mark R Zonfrillo Journal: J Pediatr Date: 2016-07-14 Impact factor: 4.406
Authors: Vikram Jairam; Victor Lee; Henry S Park; Charles R Thomas; Edward R Melnick; Cary P Gross; Carolyn J Presley; Kerin B Adelson; James B Yu Journal: JAMA Oncol Date: 2019-07-01 Impact factor: 31.777
Authors: Emily L Mueller; Seethal A Jacob; Anneli R Cochrane; Aaron E Carroll; William E Bennett Journal: Pediatr Blood Cancer Date: 2020-04-10 Impact factor: 3.167
Authors: Donna R Rivera; Lisa Gallicchio; Jeremy Brown; Benmei Liu; Demetrios N Kyriacou; Nonniekaye Shelburne Journal: JAMA Oncol Date: 2017-10-12 Impact factor: 31.777